Provider Demographics
NPI:1235742818
Name:IOCCA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:IOCCA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-787-5210
Mailing Address - Street 1:2000 SPRING ARBOR RD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3693
Mailing Address - Country:US
Mailing Address - Phone:517-787-5210
Mailing Address - Fax:517-787-9223
Practice Address - Street 1:2000 SPRING ARBOR RD STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3693
Practice Address - Country:US
Practice Address - Phone:517-787-5210
Practice Address - Fax:517-787-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental